Background. Increasing rates of both primary and repeated caesarean birth (CS) are an issue of international concern as theycan impact negatively on maternal and fetal morbidity and mortality. Increasing rates of both primary and repeated CS birthare an issue of international concern as they can impact negatively on maternal and fetal morbidity and mortality.Aim. The aim was to explore morbidity and mortality relating to repeat CS in JordanMethod. A retrospective cohort study was conducted in two large public hospitals, with data collected on repeat caesareanbirth outcomes for mothers who gave birth in the North of Jordan from June 2005 to June 2010. A specifically designedabstraction form was used to collect demographics social data and maternal and infant intranatal and postnatal outcomes.The instrument was subjected to several reviews carried out by the investigators and a pilot study was conducted to ensurespecificity and clarity. All women who had multiple repeated CS were divided into two groups, women who had three CS andwomen who had four CS and more, in order to compare the incidence of maternal and neonatal morbidity and mortality rates.Ethical approval was granted from the Human Subject Committee at Jordan University of Science and Technology. This studywas funded by Jordan University of Science and Technology.Results. The total sample consisted of 265 women; the majority had three previous CS (n=175, 66%), while 66 (25%) hadfour CS, 22 (8.3%) had five CS, one (0.4%) had six CS, and one (0.4%) had seven CS. A total of 42 women (15.8%) hadadhesions, 28 (10.6%) had placenta praevia, 23 (8.7%) needed blood transfusion, 18 women (6.8%) had a hysterectomy, 10women (3.8%) suffered uterine rupture, two women (0.8%) had placental abruption, two women (0.8%) had bladder injury,and two women (0.8%) developed disseminated intravascular coagulopathy (DIC). Compared with group of women withthree previous CS, the group of women with four CS and more had a significantly higher mean age, lower mean for gestational age, increased need for blood transfusion and were more likely to experience placenta praevia.Conclusion and implications. Multiple repeated CS pose potentially serious risks for maternal and neonatal health, whichincrease with the rising number of repeated CS. Therefore, women should be fully informed about the serious risks of multiple repeated CS and should be offered proper counselling by senior obstetrician and midwives for vaginal birth after CS,.
|Journal||Evidence Based Midwifery|
|Publication status||Published - 11 Apr 2017|
Bibliographical noteReference text: Abu-Heji A, Zayed F. (1998) Primary and repeated caesarean sections:
comparison of indications. Journal of Obstetrics and Gynaecology 18:
Al Rifai R. (2014) Rising caesarean deliveries among apparently lowrisk
mothers at university teaching hospitals in Jordan: analysis of
population survey data, 2002-2012. Global Health Science and Practice
Alchalabi HA, Amarin ZO, Badria LF, Zayed FF. (2007) Does the
number of previous caesarean deliveries affect maternal outcomes
and complication rates? WHO EMRO-Eastern Mediterranean Health
Journal 13(3): 544-550.
Amarin Z, Alchalabi H, Khder Y, Gharaibeh A, Shwayat R. (2006)
Variations in repeated caesarean section complication rates among 3
hospitals in northern Jordan? WHO EMRO-Eastern Mediterranean
Health Journal 12(5): 610-617.
Clarke M, Savage G, Smith V, Daly D, Devane D, Gross MM, M,…
Begley C. (2015). Improving the organisation of maternal health
service delivery and optimising childbirth by increasing vaginal
birth after caesarean section through enhanced women-centred care
(OptiBIRTH trial): study protocol for a randomised controlled trial
(ISRCTN10612254). Trials 16: 542. See: http://doi.org/10.1186/s13063-
015-1061-y (accessed 7 February 2017).
El-Zanaty F, Way A. (2009). Egypt demographic and health survey 2008.
Ministry of Health, El-Zanaty and Associates, and Macro International:
Gedikbasi A, Akyol A, Bingol B, Cakmak D, Sargin A, Uncu R, Ceylan Y.
(2010) Multiple repeated caesarean deliveries: operative complications
in the fourth and fifth surge in urgent and elective cases. Taiwan J
Obstet Gynecol 49(4): 425-431.
Guise JM, Eden K, Emeis C, Denman MA, Marshall N, Fu RR, Janik
R, Nygren P, Walker M, McDonagh M. (2010) Vaginal birth after
caesarean: new insights on maternal and neonatal outcomes. Evidence
Report technology assessment (full report). 191:1-397 See:DOI:10.1097/
AOG.0b013e3181df925f [PubMed (accessed 6 May 2016).
Gungorduk, K; Asicioglu,O. Celikkol, S; Sudolmus, S ;& Ark, C . (2010)
Iatrogenic bladder injuries during caesarean delivery: a case control
study. Journal of Obstetrics and Gynaecology 30(7): 667–670. See:
10.3109/01443615.2010.486086. (accessed 3November 2016).
Hamel K. (2007) Incidence of adhesions at repeat caesarean delivery,
American Journal of Obstetrics & Gynecology e31-32.
Liang-kun Ma, Na Liu, Xu-ming Bian, Li-rong Teng, Hong Qi, Xiao-ming
Gong, Jun-tao Liu, Jian-qiu Yang. (2009) Pregnancy outcomes of repeat
caesarean section in Peking Union Medical College Hospital. Chinese
Medical Sciences Journal 24 (3): pp 147-150.
Lumbiganon P1, Laopaiboon M, Gülmezoglu AM, Souza JP,
Taneepanichskul S, Ruyan P, Attygalle DE, Shrestha N, Mori R,
Nguyen DH, Hoang TB, Rathavy T, Chuyun K, Cheang K, Festin M,
Udomprasertgul V, Germar MJ, Yanqiu G, Roy M, Carroli G, Ba-Thike
K, Filatova E, Villar J. (2010) Method of delivery and pregnancy
outcomes in Asia: the WHO global survey on maternal and perinatal
health 2007-08. Lancet 6;375 (9713): 490-9. doi: 10.1016/S0140-
6736(09)61870-5. See: https://www.ncbi.nlm.nih.gov/pubmed/20071021
(accessed 30June 2016)
Lyell, D (2011) Adhesions and perioperative complications of repeat
caesarean delivery. American Journal of Obstetrics & Gynecologyvol
issue pages See: www.AJOG.org s11-s18. (accessed 10 November 2016).
Marshall N.E, Fu R, Guise J M. (2011) impact of multiple caesarean
deliveries on maternal morbidity: A systematic review. Am J Obstet
Gynecol 205(3): e1-8.
Martin J A, Hamilton BE, Ventura SJ, Osterman MJK, Wilson EC Mathews
MS. Division of Vital Statistics. (2012) Births: final data for 2010.
National Vital Statistics for USA Report 61 (1)See: http://www.cdc.gov/
Nisenblat V, Barak S, Griness O B, Degani S, Ohel G, Gonen R. (2006)
Maternal complications associated with multiple caesarean deliveries.
Obstet Gynecol 108(1):21-6.
Potter J E, Hopkins K, Faundes A, Perpetuo I. (2008). Women’s autonomy
and scheduled caesarean sections in Brazil: a cautionary tale. Birth,
Rahman J, AL-Ali M, Qutub H O, AL-Suleiman S S, AL-Jama F E, Rahman
M S. (2008) Emergency obstetric hysterectomy in a university hospital:
A 25-year review. Journal of Obstetrics and Gynaecology 28(1): 69 – 72.
Rashid M, Rashid R. (2004) Higher order repeat caesarean sections: how
safe are five or more? BJOG: an International Journal of Obstetrics
and Gynaecology Vol. 111, pp. 1090–1094 DOI: 10.1111/j.1471-
Royal College of Obstetricians and Gynaecologists (RCOG) (2015) Birth
After Previous Caesarean Birth. Green-top Guidelines No. 45. Royal
College of Obstetricians and Gynaecologists (RCOG). See: https://www.
rcog.org.uk/guidelines (accessed 12 December 2016).
Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA,
Moawad AH, Caritis SN, Harper M, Wapner RJ, Sorokin Y, Miodovnik
M, Carpenter M, Peaceman AM, O’Sullivan MJ, Sibai B, Langer O,
Thorp JM, Ramin SM, Mercer BM, for the National Institute of Child
Health and Human Development Maternal-Fetal Medicine Units
Network. (2006) Maternal morbidity associated with multiple repeat
caesarean deliveries. Obstetrics& Gynecology Vol.107, (6):1226–32.
The World Bank (2016). Jordan Economic Monitor: reviving a slowing
economy See: http://www.worldbank.org/en/country/jordan/overview
(accessed 4 August 2016).
Tulandi T, Agdi M, Zarei A, Miner L, Sikirica V. (2009) Adhesion
development and morbidity after repeat cesarean delivery. American
Journal of Obstetrics& Gynecology 201:56 e1-6.
Waqarunissa A, Fkharunissa W, Qamarunissa M, Raheela B. (2016)
Maternal complications in repeated Caesarean section. Innovative
Journal of Medical and Health Science, [S.l.], v. 6, n. 2, apr. 2016.
ISSN 2277-4939. See: at http://innovativejournal.in/ijmhs/index.2016
(accessed 14 September2016).
WHO Global Health Observatory (GHO) (2015) Data for the years
1990-2015. See: http://www.who.int/gho/maternal_health/countries/en/
(accessed 15 March 2016).
World Health Organization (2015) WHO statement on caesarean section
rates, See: at http://www.who.int/reproductivehealth/publications/
World Health Organization Regional Office for Europe. (1985) Joint
Interregional Conference on Appropriate Technology for Birth. WHO:
- caesarean delivery
- multiple repeated caesarean delivery
- maternal morbidity
- neonatal morbidity